December 9, 2011

I met today with staff from Bispebjerg Hospital, one of the main hospitals for the Capital Region of Denmark. The area around the hospital is home for the migrant population and other disadvantaged groups.I first met with the Director for Orthopaedics (and president of the national orthopaedic body) who rose very quickly to a senior role in the Danish Health Board but was required to relinquish his clinical work. After a few years, he realised that he missed this work and returned as Director, where he has been able to mainatin a small amount of subspecialty work. He has a nursing co-director and feels that it's a fairly equal relationship between them. Further to this he described Danish people as 'the most democratic people in the world' who have no hesitation in speaking up to him. His phrase was 'When I ask someone to do something, they don't ask "When?", they ask "Why?"'.
I was interested in his view of the major structural and functional changes in Danish healthcare over the last few years, in particular, the fact that a number of hospitals had been closed. He felt that Danish people and clinicians, in particular, understood that these moves were important to maintain quality and to reduce waste. He said that, as Head of Dept, he has had to find ways to increase productivity for a reduced budget. They have an ALOS of 3 days for joint replacement surgery and have increased productivity by 17% over the last few years. He felt that he had a strong voice in hospital decisions and at Region and national level. This was partly because of his own leadership qualities but also because the structure of the system allowed him clear opportunities. Another interesting thing was that he was asked by the Danish Health Board to provide criteria for referral to specialist orthopaedic clinics for OA - a similar process to our HealthPathways.
I spoke after this with the Medical Director of the hospital. He no longer has any clinical role but he has a very structured approach to involving his clinical directors in decision making in his hospital which includes regular meetings as individuals and as a group. The clinical directors are responsible for the quality and efficiency of their departments and no decision about their departments is made without them present and part of the discussion. The medical Director could not envisage a situation where his clinical leaders would not be part of the decision-making process.

Most staff ride their bicycles to work.

Bispebjerg Hospital, Copenhagen

I then had the opportunity to meet the 2 clinical leads for the Dept for Integrated Care - a general physician and a geriatrician who no longer worked clinically. They are trying to work through pathways with their GPs and are working on ways of evaluating any changes they make. They were very interested in the HealthPathways program. To me, their work was the evaluation side to our implementation work so I'm hoping to speak with them again when they're closer to developing their assessment tool.